What are the responsibilities and job description for the Medical Claims Processor position at Robert Half?
We are offering a short-term contract employment opportunity for a Medical Claims Processor in Rancho Cordova, California. This role operates within the healthcare industry, focusing on the careful review and processing of claims from Out of Group providers. As a Medical Claims Processor, you will determine the appropriateness of claims for payment based on various criteria and also ensure that denied claims are correctly recorded in the system.Responsibilities: • Review and process claims according to established policies and procedures• Determine the eligibility, benefits, authorizations, coding, compliance, and contracted payment terms of claims• Apply correct terms to claims as contracts change annually• Ensure accurate denial of inappropriate claims in the system for correct letter printing• Adhere to internal, external, and governmental timeliness standards consistently• Pay or deny medical services using department policy guidelines• Handle sensitive and confidential information appropriately• Refer claims and documentation that do not meet department policy guidelines to the UM department as necessary• Communicate with Eligibility, Member Services, UM, providers, the Health Plans, and applicable staff when required• Maintain production and quality standards• Work independently on assigned tasks and activities based on established policies and procedures.
Salary : $25
